Shoulder (superior-inferior axial view)
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At the time the article was created Andrew Murphy had no recorded disclosures.View Andrew Murphy's current disclosures
At the time the article was last revised Amanda Er had the following disclosures:
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The axial shoulder view is a supplementary projection to the lateral scapula view for obtaining orthogonal images to the AP shoulder. It is an appropriate projection to assess suspected dislocations, proximal humerus pathology, and glenohumeral articular surface abnormalities 1-3.
The axial view provides additional information when assessing dislocations and glenohumeral instability; particularly if these are not seen well on a standard AP view 4. If the positioning is difficult to achieve, the inferior-superior axial view can be performed instead.
- patient seated next to the image receptor
- image receptor at mid thoracic height
- affected arm is abducted with the elbow resting on the detector
- the arm must be abducted enough that the glenohumeral joint is central to the image detector (the patient may need to lean slightly)
- the patient's head is to be tilted away towards the unaffected side (and slightly forward if possible); check your collimation light to ensure the head will not be irradiated.
- axial projection (superior-inferior)
- glenohumeral joint with a 5-15° degree towards the patient's elbow
- anterior-posterior to the skin margins
- lateral to proximal third of the humerus
- medial to include glenohumeral joint
- 18 cm x 24 cm
- 8-15 mAs
- 100 cm
Image technical evaluation
- clear visualization of the humeral head (with no superimposition)
- relationship of the humeral head to the glenoid of the scapula
- assessment of the acromion and the coracoid process
Obtaining this projection can cause great discomfort even in healthy patients. The standard axial view as described may not be suitable for patients with dislocations or significant glenohumeral trauma. In these cases, it may be best to perform a modified trauma axial projection of the glenohumeral joint 5.
- 1. John Lampignano, Leslie E. Kendrick. Bontrager's Textbook of Radiographic Positioning and Related Anatomy. (2017) ISBN: 9780323399661 - Google Books
- 2. A. Stewart Whitley, Charles Sloane, Graham Hoadley et al. Clark's Positioning in Radiography 12Ed. (2005) ISBN: 9780340763902 - Google Books
- 3. Merrill, V. Shoulder girdle. in: P.W. Ballinger (Ed.) Merrill’s atlas of radiographic positions and radiographic procedures. 6th ed. Mosby, St Louis, Mo; 1986: 101–150 Google Books
- 4. Marschall B. Berkes, Joshua S. Dines, Jacqueline F. Birnbaum, Lionel E. Lazaro, Tristan C. Lorich, Milton T. M. Little, Joseph T. Nguyen, Dean G. Lorich. The Axillary View Typically Does Not Contribute to Decision Making in Care for Proximal Humeral Fractures. (2015) HSS Journal ®. 11 (3): 192. doi:10.1007/s11420-015-9445-9 - Pubmed
- 5. Neep M & Aziz A. Radiography of the Acutely Injured Shoulder. Radiography. 2011;17(3):188-92. doi:10.1016/j.radi.2011.01.006